中国实用外科杂志

中国实用外科杂志

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一期扩张法经皮经肝胆道镜在肝内外胆管结石治疗中的应用（附35例报告）

楼健颖，陈    伟，王    冀，梁廷波   

  1. 浙江大学医学院附属第二医院肝胆胰外科  浙江省胰腺病重点实验室，浙江杭州 310009
  • 出版日期:2017-08-01 发布日期:2017-07-25

  • Online:2017-08-01 Published:2017-07-25

摘要：

目的    探讨一期扩张法经皮经肝胆道镜（PTCS）在处理肝内外胆管结石时的适应证、方法、疗效和安全性。方法    回顾性分析浙江大学医学院附属第二医院2015年1月至2017年4月行一期扩张法PTCS治疗肝内外胆管结石35例病人的临床资料。所有病例均利用经皮经肝穿刺胆道引流一期扩张建立经皮经肝胆管窦道，并经窦道取石。分析病人临床资料、围手术期并发症发生率，以及术后病人胆管结石复发等情况。结果    35例病人均在超声引导下完成一期扩张法PTCS。18例肝胆管结石和5例胆总管结石病人完全取净结石，结石完全取净率为65.7%（23/35），8例（22.9%）肝胆管结石病人近全取净结石，结石基本取净率（包含结石完全取净和近全取净）为88.6%（31/35）。发生穿刺窦道出血1例，后期经皮经肝窦道断裂1例，无腹腔内出血、胆漏、开腹手术等严重并发症。随访时间为1～28个月。23例完全取净结石病人中6例出现结石复发，复发率26.1%，未发现远期并发症。结论    对于无法或不宜手术，以及不宜行十二指肠镜的老年病人，一期扩张法PTCS处理肝内外胆管结石安全可行，疗效满意。

关键词: 经皮经肝胆道镜, 经皮经肝穿刺胆道引流, 肝胆管结石, 胆总管结石, 胆道镜

Abstract:

A one-stage percutaneous tract dilation technique in percutaneous transhepatic cholangioscopy (PTCS) for patients with bile duct stones: A report of 35 cases        LOU Jian-ying, CHEN Wei, WANG Ji, et al. Department of Hepato-Pancreato-Biliary Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
Corresponding author: LIANG Ting-bo, E-mail: liangtingbo@zju.edu.cn
Abstract    Objective    To evaluate the safety, efficiency, indications and procedure of percutaneous transhepatic cholangioscopy (PTCS), using a one-stage percutaneous tract dilation technique, in patients with intrahepatic and/or common bile duct stones. Methods    The medical records of 35 cases of intrahepatic and/or common bile duct stones treated by PTCS, using a one-stage tract dilation technique, from January, 2015 to April, 2017 in the Second Affiliated Hospital of Zhejiang University School of Medicine were studied retrospectively. All the patients were treated with lithotripsy and basket stone removal through PTCS using one-stage percutaneous tract dilation technique after percutaneous transhepatic cholangial  drainage (PTCD). The perioperative morbitity, stone clearance rate, and stone recurrence rate were analyzed. Results    The intrahepatic biliary duct and common bile duct were successfully accessed in all 35 cases using ultrasound-guided one-stage percutaneous tract dilation PTCS technique. The stones were completely removed (level A) in 65.7% (23/35) of the cases including 18 cases of intrahepatic stones and 5 cases of common bile duct stones. The stones were almost cleared (level B) in 22.9% (8/35) of intrahepatic stones cases. Stone clearance was achieved in 31 (88.6%) cases (level A and B). One case suffered PTCD site bleeding and one case had percutaneous transhepatic tract rupture during the secondary stone removal procedure. There were no other serious procedure-related complications such as life-threatened bleeding, bile leak and conversion to laparotomy. With follow-up of 1-28 months, 6 (26.1%) of 23 cases of level-A stones clearance had recurrent intrahepatic stones and cholangitis. Conclusion    PTCS using one-stage dilation of the tract, is an effective, safe and alternative minimal invasive method for intrahepatic and/or common bile duct stones when surgery or peroral approach is not indicated.

Key words: percutaneous transhepatic cholangioscopy；percutaneous transhepatic cholangial drainage； intrahepatic stones； common bile duct , stones； cholangiocopy